Diabetic neuropathies are among the most frequent complication of long-term diabetes. It is estimated that 60% to 70% of diabetics have mild to severe forms of nervous system damage. The femoral nerve is commonly involved giving rise to symptoms in the legs and feet. Pain is the chief symptom and tends to worsen at night when the person is at rest. It is usually relieved by activity and aggravated by cold. Paraesthesias are a common accompaniment of the pain. Cramping, tenderness and muscle weakness also occur but atrophy is rare. Advanced femoral nerve disease is a major contributing cause of lower extremity amputations. Another common complication of diabetes is retinopathy (eye disease). Changes occurring in the eye which are distinctive of diabetes involve the narrowing, hardening, bulging, hemorrhaging or severing of the veins and capillaries of the retina. This is a serious complication and may lead to loss of vision. In addition to these two common complications, the diabetic state is associated with earlier and more severe vascular changes than normally occur at a given age. Cardiovascular- renal disease is the leading cause of death among diabetics. Atherosclerosis can be accurately described as the end stage of Type 1 and Type 2 diabetes, since the vast majority of diabetes patients will die from an atherosclerotic event.
Nephropathy is a common and important accompaniment of diabetes and one that in young diabetics takes precedence over heart disease as a cause of illness and death. As with eye changes, there is a wide variation in the type and degree of renal damage. Nephropathy is less frequent than retinopathy and where it occurs is also a development of long standing diabetes. Nevertheless, diabetes is the leading cause of end-stage renal disease in the US, accounting for about 40% of new cases. Low blood sugar (hypoglycemia) is another complication to be aware of – if there is too much insulin in the body compared to the amount of blood sugar, and the blood sugar falls below normal levels, a condition known as hypoglycemia occurs. This problem of hypoglycemia due to insulin or oral hypoglycemic drugs is much more common in Type 1 than Type 2 diabetes since the Type 1 diabetic is directly injecting insulin. If too much insulin is administered, or the person misses a meal or over-exercises, hypoglycemia may result. In this condition, commonly referred to as insulin shock, the brain is deprived of an essential energy source.
Based on the 1989 US National Health Interview Survey, diabetics are more likely than the general population to report a number of digestive conditions, including ulcers, diverticulitis, symptoms of irritable bowel syndrome, abdominal pain, constipation, diarrhea and gallstones. Periodontal disease, which can lead to tooth loss, occurs with greater frequency and severity among diabetics. Periodontal disease has been reported to occur among 30% of people aged 19 years or older with Type 1 diabetes. Another acute complication more likely to occur in the IDDM is ketoacidosis, a condition caused by a lack of insulin leading to a build-up of ketoacids. Chemical compounds called ketones are one of the natural by-products of fat metabolism. Excessive ketone bodies are formed by the biochemical imbalance in uncontrolled or poorly managed diabetes. The condition known as diabetic ketoacidosis can directly cause an acute life-threatening event, a diabetic coma.
Research studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, for every 1% reduction in results of A1C blood tests (e.g., from 8.0% to 7.0%), the risk of developing microvascular diabetic complications (eye, kidney and nerve disease) is reduced by 40%. Blood pressure control can reduce cardiovascular disease (heart disease and stroke) by approximately 33% to 50% and can reduce microvascular disease (eye, kidney and nerve disease) by approximately 33%. In general, for every 10 millimeters of mercury (mm Hg) reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12%. Improved control of cholesterol or blood lipids (for example, HDL, LDL, and triglycerides) can reduce cardiovascular complications by 20% to 50%. Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50% to 60%. Comprehensive foot care programs can reduce amputation rates by 45% to 85%. Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30% to 70%. Treatment with ACE inhibitors and angiotensin receptor blockers (ARBs) are more effective in reducing the decline in kidney function than other blood pressure lowering drugs.
Sometimes a complication of diabetes may give a clue to the presence of the disease. The principle complications or sequelae associated with diabetes are retinopathy, neuropathy, nephropathy and arteriosclerosis. Whether these are the unavoidable consequences of the diabetic state over time or whether they may be influenced by controlling the diabetes through aggressive monitoring, treatment and life-style management, including diet and supplements, remains a central topic. To prevent problems, keep your blood sugar level as close to normal as possible and follow your doctor’s instructions. Eat a variety of healthy foods and avoid foods that are high in fat, cholesterol, salt and added sugar. Be very careful of supplements – for example, fish oil capsules or supplements containing large amounts of para-aminobenzoic acid (PABA) can elevate blood sugar. Also, supplements containing cysteine interfere with absorption of insulin by cells and very large dosages of vitamins B1 or C may inactivate insulin. Maintain a healthy weight. If you’re overweight, your doctor can give you advice on how to lose weight safely. Control your blood pressure and cholesterol levels. Be physically active on a regular basis. If you smoke, quit! See your doctor on a regular basis even when you feel fine. Your doctor will check for early signs of complications.